Continuity of Care Document ^

Patient Info

note

reason for referral

problems

mental status

allergies and adverse reactions

medications

procedures

social history

results

vital signs

encounters

plan of treatment

goals

medical equipment

Authoring Details

Signatures

Continuity of Care Document

for b8a7ca3c-501f-45a0-9b02-c3accffd3e88

OID: 2.16.840.1.113883.3.1110

Table of Contents

Patient Info

note

reason for referral

problems

mental status

allergies and adverse reactions

medications

procedures

social history

results

vital signs

encounters

plan of treatment

goals

medical equipment

Authoring Details

Signatures

Patient Info

Patient NameGeorgette Dietz

Patient Identifiers8X301752116

OID: 2.16.840.1.113883.3.1110.2.1.19614

Patient Contact

Home: 2550 W 96TH AVE LOT 100

DENVER, CO 80260-5737

US Tel:

+1-720-***-****

Date of Birth06/2/1966

SexFemale

Preferred Languageen

Race

EthnicityHispanic or Latino

Related Visits

Care team seen

Stolcis Katherine Mary PA performer

Lee Chanida R4 DO performer

Arroyo Richard R2 DO performer

KENMA99 performer

Vangeti Pramod MD performer

Baulesh David DO performer

Loner Carly MD performer

Lepczyk Laura Elizabeth DO performer

Bershof John Fox MD performer

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performer

performer

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performer

Sharon McKelvey performer

Oswald Tanya Monique performer

Knowles McKay DO performer

Como Alan James MD performer

Dutton-Swain Nicholas MD performer

McCarthy,Christopher James performer

Robinson Zachary David MD performer

KNOW DOES NOT performer

ROGCHG performer

Cameron Drew MD performer

Chisholm William Marshall MD performer

MANAGEMENT CASE performer

REFERRED SELF performer

SHARON MCKELVEY performer

INFCE performer

Rivera Alfredo Nicodemus MD performer

CBN performer

MR performer

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CSS.AA34 performer

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FPAR.GM performer

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Knowles McKay DO - 15-Jul-2022

• MEDICAL CENTER OF AURORA (COCAA) Psychiatric Discharge Summary REPORT#:0715-0461 REPORT STATUS: Signed DATE:07/15/22 TIME: 1145 PATIENT: DIETZ,GEORGETTE UNIT #: E001296729 ACCOUNT#: E40016196245 ROOM/BED: G.3016-01 DOB: 06/02/66 AGE: 56 SEX: F ATTEND: Knowles,McKay DO ADM DT: 07/12/22 AUTHOR: Knowles,McKay DO Report Service Date:07/15/22 * ALL edits or amendments must be made on the electronic/computer document * KENNON,MASON 07/15/22 1145: Medication Reconciliation Rpt Discharge Meds Stop taking the following medications: glipiZIDE XL (GLUCOTROL XL) 5 MG TAB.ER.24H 5 MILLIGRAM ORAL BEDTIME Metformin (Glucophage) 500 MG TAB 1,000 MILLIGRAM ORAL TWICE DAILY [? DIABETIC MED] DAILY Continue taking these medications: DAPAGLIFLOZIN PROPANEDIOL (FARXIGA) 5 MG TAB 5 MILLIGRAM ORAL DAILY PREGABALIN (LYRICA) 150 MG CAP 150 MILLIGRAM ORAL TWICE DAILY Start taking the following new medications: hydrOXYzine PAMOATE (VISTARIL) 50 MG CAP 50 MILLIGRAM ORAL EVERY 4 HOURS AS NEEDED as needed for ANXIETY Days = 30 Qty = 30 No Refills VENLAFAXINE XR (EFFEXOR XR) 37.5 MG CAP.SR.24H 37.5 MILLIGRAM ORAL DAILY Days = 30 Qty = 30 No Refills The following medications have been changed: Old: Metformin (Glucophage) 500 MG TAB 500 MILLIGRAM ORAL TWICE DAILY Days = 30 Qty = 60 New: Metformin (Glucophage) 500 MG TAB 500 MILLIGRAM ORAL DAILY Days = 30 Qty = 30 Physical Exam Mental Status Exam Level of alertness: alert Orientation: awake, alert, oriented X4 Appearance: bizarre Mood: anxious, depressed Affect: cong. w/thought content Behavior: anxious (slightly), relaxed Attitude: open SI/HI: denies Sleep: Sleep concerns: difficulty falling asleep, sleep cont. disturbance, insomnia Speech: normal rate rhythm Language: articulate, logical,goal directed Thought processes: coherent goal directed Associations: intact Thought content: no delusions elicited Hallucinations: denies Memory: Short term: intact Long term: intact Attention: adequate Concentration: adequate Intellect: normal Fund of knowledge: good Insight/Judgment: insight and judgement improved Strengths and Disabilities Strengths: able to feed self, able to ambulate, can maintain some ADL's, career opportunity, does not resist nsg help, good physical health, good social support, medication compliance, medically stable, positive attitude Physical Exam General appearance: alert, awake, oriented Musculoskeletal: normal inspection Gait: normal Neuro/CNS: normal inspection, normal speech General Information Date of admission: Date of admission: 07/12/22 Discharge Diagnosis (Primary/Secondary Psych): Major depressive disorder Insomnia, persistent Nicotine use disorder Other Diagnosis: Diabetes type II Brief HPI: HPI: The patient Georgette Dietz is a 56-year-old female with a history significant for questionable schizophrenia, depression, anxiety, non-insulindependent diabetes, meningioma, and chronic UTI's, who presents on an M1 due to suicidal ideation, possible suicide attempt, in the context of insomnia and medication noncompliance x5 yrs. Patient reportedly took 4 tabs of Seroquel to "sleep and not wake up"; currently denies all SI or previous intent: "I wan't trying to kill myself, I was just trying to get some sleep". She does endorse persistent passive SI. The patient has been off all medications x5 years, with the exception of Lyrica. She endorses worsening sleep difficulty (only 1-3 hours sleep/night) since starting night shift at an assisted living facility x6 months. She also reports difficulty obtaining help for health care and medications, although attributes this to her own lack of prioritizing her health. Per patient's family, she has frequently been making statements of wanting to go to sleep and not wake up. Pt reports history of non-malignant brain tumor "wrapped around my brain stem ... it keeps growing". She denies current provider, last MRI 5 yrs ago. She also reports current L side sinus infection and upcoming scheduled appt w provider. Of note, pt's glucose =390 at time of admit (7/12 @2330), previously =452 at 2138 (received 10 units humalog and 500 mg metformin in the ED), =252 at 2004, =477 at 1512 (received 10 units humalog). Patient reports known history of diabetes but admits that she has not been taking her metformin or insulin x 5 yrs. Hospital course: DISCHARGE DATE: 7/15/2022 DISCHARGE DIAGNOSES: Major depressive disorder, insomnia, persistent, nicotine use disorder. HOSPITAL COURSE: Georgette was admitted to The Medical Center of Aurora, North Campus Inpatient Psychiatric Unit in stable condition. Every 15 minute safety checks were started per unit protocol, and home medications were continued. Primary care was consulted for routine care, and nutrition was consulted to evaluate and treat as appropriate. Labs from the outside ER were reviewed. A family meeting was not held where diagnoses, medication options, therapy recommendations, and discharge planning was discussed. Georgette was noted to interact well with peers and staff throughout hospitalization and showed no agitation, aggression, or self-injury. Georgette participated well in group/ milieu activities and was an active member. After discussion of risks, benefits, and alternatives, Georgette was started on Venlafaxine 37.5 and Vistaril 50 mg. There were not side effects reported. In the days prior to discharge, Georgette expressed future orientation and reported no plan or intention for suicide. She denied any thoughts of harm towards others. She was able to safety plan (constructed a written safety/ coping plan for future reference), and parents agreed to have all medications within the home secured and denied that there were any unlocked guns in the home. At the time of discharge, Georgette acknowledged and agreed with the plan for ongoing need for active engagement in mental health services. CHRONOLOGY OF ADMISSION: Georgette was admitted overnight on 7/12 after taking 4 seroquel "to go to sleep" and making suicidal statements to family members. Georgette was started on Effexor 37.5 ER mg and given vistaril 50 mg q4 PRN for anxiety. From the point of admission, she denied frank suicidal ideation and denied that her "overdose" was intentional. Continued to deny SI/HI or AH/VH throughout the course of her hospitalization. Her affect improved during hospitalization which she attributed to better sleep and the effects of the medications. She denied medication side effects. Of note, patient was found to have blood sugar greater than 400 in the ED and states she has not been compliant with diabetes medications. Patient was given 30 day prescription of her home Metformin dose but will need OP follow up with a PCP or internist to improve her blood sugars. DISCHARGE MEDICATIONS: see reconciled list PROCEDURES: No procedures were performed during admission CONDITION UPON DISCHARGE: Improved DISCHARGE INSTRUCTIONS: -Maintain strict follow up appointments with OP providers -Refer to safety plan developed while hospitalized in times of distress -For thoughts of suicide or violence with intent to act, present to nearest emergency department -Avoid/refrain from any psychoactive substances that may impair judgement -Continue any medications as prescribed to you upon discharge -Important to follow up with PCP or internist for diabetes management Greater than 30 minutes spent coordinating discharge including safety planning, providing psychoeducation on medications, securing timely follow up, and discussing behavior planning. Treatments Procedures Lab: Laboratory Tests Test Result Date Time Chemistry POC Glucose (74 - 106 mg/dL) 282 H 07/15 1150 Fasting Glucose (70 - 99 mg/dL) 316 H 07/13 0620 Est Mean Plasma Glucose mg/dL) 07/13 0620 Hemoglobin A1c (<5.7) >14.0 H 07/13 0620 Triglycerides (<150 mg/dL) 174 H 07/13 0620 Cholesterol (<200 mg/dL) 207 H 07/13 0620 LDL Cholesterol, Calc 130 H 07/13 0620 Non-HDL Cholesterol (<130) 161 H 07/13 0620 HDL Cholesterol (> OR = 50 mg/dL) 46 L 07/13 0620 Cholesterol/HDL Ratio (<5.0 (calc)) 4.5 07/13 0620 Discharge Instructions Discharge to: home Activity: ambulate Diet: cardiac Prescriptions: with patient Quality Current Medications Current medication review: I attest that the foregoing medication list in the medical record is true, accurate, and complete to the best of my knowledge. KNOWLES,MCKAY DO 07/18/22 0825: General Information Legal hold status: ***NOTE: The documentation below has been imported from the legal hold status order. Any changes to the patient's legal hold status MUST be entered in the order. Initial legal hold status: Involuntary Updated legal hold status: Date legal status changed: Aftercare recommendation: outpatient treatment Pt. condition on discharge: improved Allergies: Allergies: No Known Allergies (Coded, 07/13/22) Discharge Instructions Discharge management: greater than 30 mins Emergency instructions: The patient was instructed to present to the nearest Emergency Department or call 911 should their symptoms return or worsen. Attestations Physician Attestation Agree w/findings plan: Agree with the findings and plan as documented by Dr. Kennon. Georgette is w/o SI/HI/AVH upon discharge, and has appropriate f/u care in place. Getting consistent sleep appeared to be most helpful for her. Electronically Signed by Kennon,Mason MD R1 on 07/15/22 at 1221 Electronically Signed by Knowles,McKay DO on 07/18/22 at 0827 RPT #: 0715-0461 ***END OF REPORT***

Knowles McKay DO - 14-Jul-2022

• MEDICAL CENTER OF AURORA (COCAA) Psychiatric Progress Note REPORT#:0714-0507 REPORT STATUS: Signed DATE:07/14/22 TIME: 1302 PATIENT: DIETZ,GEORGETTE UNIT #: E001296729 ACCOUNT#: E40016196245 ROOM/BED: G.3016-01 DOB: 06/02/66 AGE: 56 SEX: F ATTEND: Knowles,McKay DO ADM DT: 07/12/22 AUTHOR: Knowles,McKay DO Report Service Date:07/14/22 * ALL edits or amendments must be made on the electronic/computer document * KENNON,MASON 07/14/22 1302: Subjective Chief complaint: Chronic depression; Passive SI Interval history: 7/14: This morning Georgette was pleasant and denied any medical complaints or medication side effects. States that she slept well and feels that her depression is improved (says baseline is 8/10 and she is currently at 2/10). Continues to deny SI/HI or AH/VH. Per nursing patient slept 6 hours. States having some extra time to sleep has improved her mental health significantly. States she has little social support at home aside from her daughter Trinity 720-***-****. Have tried to contact daughter without success. Review of Systems Constitutional: No: fatigue. Respiratory: normal/no change Cardiovascular: normal/no change GI: normal/no change Objective General VS: Vital Signs: Date Time Temp Pulse Resp B/P B/P Pulse O2 O2 Flow FiO2 Mean Ox Delivery Rate 07/14 0524 35.6 80 18 112/78 89 94 Room air 07/13 2026 35.6 92 16 129/85 99 97 Room air 07/13 1454 36.0 102 19 113/81 91 93 07/13 1452 36.0 102 19 113/81 91 93 1 PATIENT WEIGHT: Weight (lb): 152 Weight (oz): 6.14 Weight (kg): 69.120 Current medications: Active Meds + DC'd Last 24 Hrs Venlafaxine HCl (EFFEXOR XR) 37.5 MG DAILY PO Metformin HCl (GLUCOPHAGE) 500 MG DAILY@08 PO Insulin Glargine (LANTUS) 10 UNITS BEDTIME SUBQ Miscellaneous Information (PATCH REMOVAL MESSAGE) LIDOCAINE PATCH 0900 - Insulin Human Regular (HumuLIN R 100 UNITS/ML) 4 UNITS AC HS PRN SUBQ Lidocaine (LIDODERM) 2 PATCH DAILY TRANSDERM Pregabalin (Lyrica) 300 MG BID PO Insulin Human Lispro (HumaLOG) Mealtime (CHO) Coverage BMI < 26 1 unit per 10 GM carbohydrates MEALS SUBQ Insulin Human Lispro (HumaLOG) SSI Bedtime Correction BMI < 26 SEE ADMIN CRITERIA BEDTIME SUBQ Dextrose/Water (DEXTROSE 50%) 25 ML PRN PRN IV (CKD) Dextrose/Water (DEXTROSE 50%) 50 ML PRN PRN IV (CKD) Glucagon (GLUCAGON) 1 MG PRN PRN IM Acetaminophen (TYLENOL 325 MG TAB) 650 MG Q6H PRN PRN PO Hydroxyzine Pamoate (VistariL) 50 MG Q4H PRN PRN PO Magnesium Hydroxide (MILK OF MAGNESIA) 30 ML Q12H PRN PRN PO Melatonin (MELATONIN) 3 MG BEDTIME PRN PRN PO Multi-Ingredient GI Drug (MAALOX) 30 ML Q4H PRN PRN PO Nicotine (NICODERM) 21 MG.PER.24H DAILY PRN PRN TRANSDERM (CKD) Nicotine Polacrilex (NICORETTE) 2 MG Q2H PRN PRN CHEW Olanzapine (ZyPREXA Zydis) 5 MG Q4H PRN PRN SL Allergies: Allergies: No Known Allergies (Coded, 07/13/22) Mental Status Exam Level of alertness: alert Orientation: awake, alert, oriented X4 Appearance: disheveled Mood: anxious, depressed Affect: cong. w/thought content Behavior: anxious (slightly), relaxed Attitude: open SI/HI: denies Sleep: Sleep concerns: difficulty falling asleep, sleep cont. disturbance, insomnia Speech: normal rate rhythm Language: articulate, logical,goal directed Thought processes: coherent goal directed Associations: intact Thought content: no delusions elicited Hallucinations: denies Memory: Short term: intact Long term: intact Attention: adequate Concentration: adequate Intellect: normal Fund of knowledge: good Insight/Judgment: insight fair, judgment limited/poor Strengths and Disabilities Strengths: able to feed self, able to ambulate, can maintain some ADL's, stable housing Physical Exam General appearance: frail, alert Musculoskeletal: normal inspection Gait: normal Cranial Nerves: Cranial nerves comments: CN 2-12 grossly intact Diagnosis, Assessment Plan Free Text A P: The patient Georgette Dietz is a very pleasant 56-year-old female with a history significant for questionable schizophrenia, depression, anxiety, non-insulin- dependent diabetes, meningioma, and chronic UTI's, who presents on an M1 due to suicidal ideation, possible suicide attempt, in the context of insomnia and medication noncompliance x5 yrs. Patient reportedly took 4 tabs of Seroquel to "sleep and not wake up"; currently denies all SI or previous intent. Current medications include Lyrica 300 mg BID. Patient purchased Seroquel from online provider approximately 1 year ago, takes sporadically (1 tab) for sleep. She denies all other medications x5 years, including all diabetes meds. Working diagnoses at this time include: Other specified depressive disorder; Other specified anxiety disorder (suspect GAD); Insomnia, persistent. Patient has a long history of unmedicated depression with passive suicidality and has trialed zoloft, prozac, paxil, wellbutrin, and cymbalta with limited therapeutic benefit (zoloft initially w/ therapeutic benefit, however that waned). Will consider starting Effexor for depressive symptoms and neuropathic pain. Patient reports history of significant back pain 2/2 to a spinal cord injury as well as neuropathy; will restart Lyrica 300 mg BID and provide lidocaine patches. Patient was admitted with hyperglycemia of 390; she received a total of 20 units Humalog and 500 mg metformin in the ED. We will start sliding scale insulin at this time. Patient also has a history of meningioma and has not seen a provider or had imaging x5 years; she also endorses current L-side sinus infection and mild dysuria (UA: hazy, nitrites negative, WBC high). Will order repeat UA at this time. The patient will benefit from hospitalist consult. Case management to assess for outpatient resources including establishing with a PCP, outpatient psychiatry and therapy. Collateral information will prove useful: daughters: Trinity (age 21), Bethany ( age 17): phone contact info in pt's cell phone w/ nursing. 7/14: Patient continues to deny SI and feels that her depression has improved in the clincial environment. We discussed the variety of social stressors she's facing including working the night shift and being somewhat lonely. Have been trying to contact patient's daughter Trinity with no success currently. Currently having no side effects from the current venlafaxine dosage; we discussed the importance of her OP follow-up to further optimize her psychiatric medications. Because of lack of suicidal ideation and improvement of mood, plan to discharge tomorrow possibly if clinical improvement continues. CERTIFICATION OF MEDICAL NECESSITY: I certify this inpatient psychiatric hospital admission is medically necessary. The patient was experiencing an acute episode of symptoms and requires ongoing inpatient care for safety monitoring, medication evaluation, therapeutic milieu, and thoughtful discharge planning. There is no lesser restrictive alternative at this time. SUICIDE RISK ASSESSMENT: We are unable to predict behavior, including whether a given patient will attempt to harm themselves or others. At most, we may identify known risk factors and attempt to treat those that are capable of responding to evidence-based interventions. Even then, the research reflects that both violent acts and suicide attempts are difficult to predict given the combination of intervening changing life circumstances outside of a clinicians control and that many only consider violence or suicide for minutes to hours prior to acting. Currently, this patient DENIES suicidal ideation. Static Suicide/Violence Risk Factors: chronic mental illness; chronic pain; current brain tumor; hx of psychiatric admissions; family hx of suicide attempts Dynamic Suicide/Violence Risk Factors: persistent passive suicidal ideation; insufficiently treated mental illness; mood dysregularity Protective Factors: access to resources; compliant with treatments while inpatient; social supports; obtaining treatment; psychotropic medications Overall chronic suicide risk: Moderate given chronic mental illness Overall acute suicide risk: Increased above baseline Overall chronic violence risk: Low given lack of reported history Overall acute violence risk: At baseline given lack of current ideation DIAGNOSES: -Other specified depressive disorder (MDD w/ anxious distress vs persistent depressive disorder w/ anxious distress vs depressive disorder d/t another medical condition) -Other specified anxiety disorder (GAD vs anxiety disorder d/t another medical condition) -Insomnia, persistent, with non-sleep disorder mental comorbidity -Nicotine use disorder, severe LEGAL STATUS: M1 (expires on 7/15 @1050) LEVEL OF OBSERVATION: -15-minute checks; denies active SI and contracts for safety MEDICATIONS: -SSI -Lyrica 300 mg BID for neuropathic pain 2/2 spinal cord injury -Lidocaine patch -Venlafaxine 37.5 mg ER for depression -Hydroxyzine 25 mg for anxiety LABS: Reviewed THERAPEUTIC INTERVENTION: -Daily Group Therapy and Milieu Activities -Individual Encounters with focus on psychoeducation and diagnostic clarification CONSULTS: -Case management/social work COLLATERAL CONTACTS: -Daughters: Trinity (age 21), Bethany (age 17): pt has phone contact info in her cell phone w/ nursing. DISCHARGE PLANNING: -Case manager to assess Estimated LOS: 6-9 days Dragon/Transcription Disclaimer: Some of this note may be an electronic transcription/transcription of spoken language to printed text. The electronic translation of spoken language may permit erroneous, or at times, nonsensical words or phrases to be inadvertently transcribed. Although I have reviewed the note for such errors, some may still exist. Legal hold status: ***NOTE: The documentation below has been imported from the legal hold status order. Any changes to the patient's legal hold status MUST be entered in the order. Initial legal hold status: Involuntary Updated legal hold status: Date legal status changed: Quality Current Medications Current medication review: I attest that the foregoing medication list in the medical record is true, accurate, and complete to the best of my knowledge. KNOWLES,MCKAY DO 07/15/22 0724: Attestations Physician Attestation Agree w/findings plan: Agree with the findings and plan as documented by Dr. Kennon. Georgette appears more optimistic and cheerful today. States she got good sleep overnight. Anticipate discharge tomorrow pending any new concerns. Electronically Signed by Kennon,Mason MD R1 on 07/14/22 at 1318 Electronically Signed by Knowles,McKay DO on 07/15/22 at 0725 RPT #: 0714-0507 ***END OF REPORT***

Stolcis Katherine Mary PA - 13-Jul-2022

• MEDICAL CENTER OF AURORA (COCAA) Hospitalist History Physical REPORT#:0713-0540 REPORT STATUS: Signed DATE:07/13/22 TIME: 1329 PATIENT: DIETZ,GEORGETTE UNIT #: E001296729 ACCOUNT#: E40016196245 ROOM/BED: G.3016-01 DOB: 06/02/66 AGE: 56 SEX: F ATTEND: Knowles,McKay DO ADM DT: 07/12/22 AUTHOR: Stolcis,Katherine Mary PA Report Service Date:07/13/22 * ALL edits or amendments must be made on the electronic/computer document * History of Present Illness HPI Chief complaint: medical consultation HPI: Patient is a 56-year-old female who was taken to North Suburban Medical Center on July 12 with suicidal ideation and sleep disturbance. Patient recently acquired a new job which requires her to work night shifts. Patient took 4 tablets of Seroquel in an effort to sleep. Her blood alcohol level upon arriving at the hospital was negative. Urine tox screen is negative. Her EKG did not show any acute ischemia.. Her blood glucose was 400. She was asymptomatic. She has a past medical history significant for chronic headaches related to meningioma as, schizophrenia, depression and type 2 diabetes. Patient was felt to be medically stable and transferred to the Medical Center of Aurora North campus for inpatient psychiatric care. History Additional medical history: PMH: Chronic headaches from meningioma, schizophrenia, depression, non-insulin-dependent diabetes, frequent UTIs, arthritis, daily smoker, anxiety, tachycardia, Additional surgical history: PSH: Complex nasal reconstruction, meningioma resection x3, low back surgery without hardware, C-section x2, hysterectomy, myomectomy Breast augmentation Additional family history: Denies family history of problems with anesthesia. Alcohol use: Denies EtOH use (hx of alcoholism 25 yrs past) Drug use: Denies recreational drugs Smoking status: Smoking status for patients 13 years old or older: Current every day smoker ( 1 pk/day x45 yrs) Date last smoked: 07/12/22 Packs per day: 20 Years smoked: 40 Pack years: 800 Additional social history: Daily smoker Medication/Allergy-Vaccine Hx Allergies: Coded Allergies: No Known Allergies (07/13/22) Review of Systems Free Text ROS Notes Free Text ROS Notes: General: denies fever, chills, weakness, weight loss, tiredness Eyes: denies irritation, drainage, pain. no new vision changes ENT: denies difficulty swallowing, no pain, no rhinorhea Head/Neck: denies masses Pulmonary: denies shortness of breath, cough, wheezing, no DOE Cardiovascular: denies chest pain, palpitations, DOE. no edema GI: denies abdominal pain. no nausea/vomiting. no diarrhea/constipation GU: denies dysuria, frequency, urgency Neurological: denies numbness, weakness, loss of function. Endocrine: denies weight loss, weight gain MSK: denies joint pain or swelling. Objective General VS/I O: Vital Signs: Date Time Temp Pulse Resp B/P B/P Pulse O2 O2 Flow FiO2 Mean Ox Delivery Rate 07/13 0000 36.4 81 18 131/88 102 94 Room air 24 hour I O ending at 0700: 07/13 0700 07/12 1900 Intake Total Output Total Balance Patient 69.12 kg Weight Weight Bed scale Measurement Method PATIENT WEIGHT: Weight (lb): 152 Weight (oz): 6.14 Weight (kg): 69.120 Free Text Obj Notes Free Text Obj Notes: General: alert, awake. Cooperative Oriented x 3 HEAD: Normocephalic, atraumatic EYES: EMOI, no redness, no drainage, conjunctiva clear. No swelling. ENT: mucousa moist NECK: supple, no masses, no JVD. no thyromegaly. no lymphadenopathy. Cardiovasular: Normal S1, S2. Regular rate and rhythm Pulmonary: clear to auscultation, no rales, rhonchi, wheezing. Normal TV Abdomen: soft, non-tender, non-distended Extremities: no joint pain or swelling. no edema Neurological: CN II, III, IV, V, VI, VII, VIII, IX, X, XI, XII intact. no focal changes, alert and oriented x 3 Diagnosis, Assessment Plan Additional comments: Spent 70 minutes reviewing patient's record meeting with patient and implementing treatment plan Free Text DxA P Notes Free Text DxA P Notes: Type 2 diabetes blood sugars quite elevated. We will start 10 units of Lantus daily. Will cover with 4 units of lispro if blood sugars are above 350. Monitor. Chronic headaches patient comfortable and doing well at this time. Monitor and offer. Medications if necessary. Schizophrenia patient with chronically and severely deformed nose after she felt that there were bugs in her skin and she began picking and destroying soft tissue. She required extensive soft tissue reconstruction. Continue current medications and supportive care. Monitor. Patient seems to have fairly good insight about this. Depression continue current medications. Anticipate needs and possible. Patient seems to be open to care and interventions now. Electronically Signed by Stolcis,Katherine Mary PA on 07/13/22 at 1336 Electronically Signed by Pauckova,Jarmila MD on 07/19/22 at 1352 RPT #: 0713-0540 ***END OF REPORT***

Arroyo Richard R2 DO - 12-Jul-2022

• MEDICAL CENTER OF AURORA (COCAA) Psychiatric Evaluation Note REPORT#:0712-0790 REPORT STATUS: Signed DATE:07/12/22 TIME: 2303 PATIENT: DIETZ,GEORGETTE UNIT #: E001296729 ACCOUNT#: E40016196245 ROOM/BED: G.3016-01 DOB: 06/02/66 AGE: 56 SEX: F ATTEND: Knowles,McKay DO ADM DT: 07/12/22 AUTHOR: Arroyo,Richard DO R1 Report Service Date:07/12/22 * ALL edits or amendments must be made on the electronic/computer document * **See Addendum** HPI/Med Hx HPI Chief complaint: Chronic depression; Passive SI )( HPI: The patient Georgette Dietz is a 56-year-old female with a history significant for questionable schizophrenia, depression, anxiety, non-insulin-dependent diabetes, meningioma, and chronic UTI's, who presents on an M1 due to suicidal ideation, possible suicide attempt, in the context of insomnia and medication noncompliance x5 yrs. Patient reportedly took 4 tabs of Seroquel to "sleep and not wake up"; currently denies all SI or previous intent: "I wan't trying to kill myself, I was just trying to get some sleep". She does endorse persistent passive SI. The patient has been off all medications x5 years, with the exception of Lyrica. She endorses worsening sleep difficulty (only 1-3 hours sleep/night) since starting night shift at an assisted living facility x6 months. She also reports difficulty obtaining help for health care and medications, although attributes this to her own lack of prioritizing her health. Per patient's family, she has frequently been making statements of wanting to go to sleep and not wake up. Pt reports history of non-malignant brain tumor "wrapped around my brain stem ... it keeps growing". She denies current provider, last MRI 5 yrs ago. She also reports current L side sinus infection and upcoming scheduled appt w/ provider. Of note, pt's glucose =390 at time of admit (7/12 @2330), previously =452 at 2138 (received 10 units humalog and 500 mg metformin in the ED), =252 at 2004, = 477 at 1512 (received 10 units humalog). Patient reports known history of diabetes but admits that she has not been taking her metformin or insulin x 5 yrs. PAST PSYCHIATRIC HISTORY: Patient reports 2 previous psychiatric hospitalizations (20 years ago). No current mental health treatment providers x6 years. The endorses hx of sexual abuse (as child), physical abuse (husband, separated), and emotional abuse. MEDICATIONS: Current medications include: Lyrica 300 mg BID (prescribed by Horizon Clinic). She ordered Seroquel from an online provider approx 1 yr ago, has been using it irregularly for sleep, unknown dose, typically takes 1 tab. She denies all other medications x5 yrs. Previous medication regimen: metformin, glipzide, periods of SQ insulin. Previous medication trials include: zoloft, prozac, paxil, wellbutrin, cymbalta. Pt states that the only medication that provided any therapeutic benefit was zoloft, however efficacy waned after 1 yr. NKDA. SUBSTANCE USE: U tox negative. Drug use: Denies Alcohol use: Denies (hx of alcoholism 25 yrs ago) Echo: Current daily smoker, 1 pk/day x45 yrs FAMILY PSYCHIATRIC HISTORY: mom, maternal grandma (bipolar, not formally diagnosed) mom, materal grandma (suicide attempts) daughter (non-diagnosed

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